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Is an abdominal Xray routine in your "appy work-up"? I think it is overused
for appendicitis.
 
Mark
 
-----Original Message-----
From: Shelley Rubinstein [mailto:[log in to unmask]]
Sent: Friday, December 10, 1999 11:00 AM
To: Multiple recipients of list PED-EM-L
Subject: many faces to an appy
 
 
Jay, Jeanne and list members_
 
Here's another one:
A 7 yo BF presented 2 days after Thanksgiving with horrible abdominal pain
and diarrhea. She had just gotten back from Mexico with her dad. No one else
was sick. They only drank bottle water. Her diarrhea had started the night
she returned from Mexico.(the evening before she presented to the ED)
 
She had orthostatic changes in her heart rate. She looked dehydrated. She
had  low grade temp. Her bowel sounds were hyperactive and she had pain in
the RLQ and some in the LLQ as well. She continued to have diarrhea (heme
positive) and no vomiting in the ED.
 
A resident  had presented the case to me as an acute gastroenteritis. Sounds
like it. But when I had seen her come in she could barely get onto the
examination table because of her abdominal pain. I told the resident to do
an "appy workup" as well (I wanted plain films along with the labs). She
thought I was crazy, but the patient looked to be in too much pain for AGE.
She had a pretty impressive fecolith on X-ray. Went to OR. Not perforated.
 
What can I say? Many faces indeed!!
Shelley Rubinstein,MD
 
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